[ effect of intra abdominal wall infiltration with bupivacaine in reducing postoperative diclofenac need in elective cesarean sections]

Considering the side-effects of opiums and NSIADS drugs such as respiratory depression, apnea and GI effects, today it has been paid more attention to intra abdominal wall infiltration of local anesthetics for this purpose. The aim of this study is to determine the effect of intra abdominal wall infiltration with bupivacaine to reduce post operative diclofenac need in elective cesarean sections. In this double- blind, placebo-controlled trial, 60 healthy women with single term pregnancy underwent spinal anesthesia were randomized into two groups. Patients, then received a combination of 30cc of bupivacaine with 1.5cc of epinephrine as intra abdominal wall infiltration or equal volume of saline in cesarean section at the time of abdominal closure. Pain was assessed using a visual analogue scale 1, 2, 3, 4,8 and 12 h after the operation. Also mean diclofenac consumption was assessed during 12 h after the operation. The final analysis was done with statistical tests by SPSS [P<0.05 was considered significant]. Mean pain scores at 1 and 2 h after the operation was significantly lower in bupivacaine group than placebo [p<0.05]. Mean diclofenac consumption was lesser in bupivacaine group than placebo [p<0.05]. Also the time we prescribed diclofenac in bupivacaine group was later [p<0.05]. Intra abdominal wall infiltration with 30cc of 0.25% bupivacaine leads to less paid and less diclofenac consumption at the first hours after cesarean section

[Comparing the effect of normal saline and sodium bicarbonate on duration of anesthesia following epidural anesthesia by lidocaine 2% in patients with femoral fracture]

Introduction: Epidural anesthesia is one of effective regional anesthesia methods for different kinds of [small and large] surgeries. Prolongation of sensory and motor block following epidural anesthesia is accompanied by long stay in PACU and more post anesthesia care requirements. One of the essential needs is limiting hospital stay and decreasing epidural anesthesia side effects. Therefore, using methods that can cause early discharge and reduce sensory-motor and sympathetic blockade period are necessary. Using crystalloid solutions is one of these methods

Objective: In this study the researcher tried to compare the effectiveness of two crystalloid solutions – normal saline and sodium bicarbonate solution – to access the best method

Materials and Methods: This research is a randomized double blind clinical trial study. Sixty ASA-II patients who had repairing surgery for fracture of femor were divided into two equal groups [thirty patients in each group]. And all of them received 20ml lidocaine 2% through epidural catheter insertion. In the end of surgery, the patient was transported to recovery room and 15ml crystalloid solution – normal saline or sodium bicarbonate – was injected and then catheter was removed. The level of sensory blockage based on blocked spinal and motor blockage were examined and registered every 15 minutes by Bromage scale [zero=none, 1=motor blockage of hip, 2=hip and knee block, 3=ankle, hip and knee block]. Data was analyzed by t-test and Anova tests by SPSS.10 software

Results: The mean age in normal saline group was 41±12 and in sodium bicarbonate group was 43±11 years. There were 13 female and 17 males in normal saline group and 15 female and 15 males in sodium bicarbonate group. The mean of regression time of sensory block of sodium bicarbonate was 92min and 50sec, and due to normal saline was 99min and 25sec. The regression time of motor block due to sodium bicarbonate was 89min and 25sec, and due to normal saline was 94min and 50sec. All results were significant [P<0.05]. The regression of sensory and motor block due to sodium bicarbonate was more rapid than normal saline. Any side effect was not detected

Conclusion: According to data obtained, it seems that using sodium bicarbonate as compared to normal saline at the end of femoral surgery improves sensory-motor blockade sensation due to injection of Lidocaine 2%soution and educes PACU stay period and improves anesthesia tolerance. This method could be used for all patients whom receive epidural anesthesia

[Investigation of the pregnancy rate after intracytoplasmic sperm injection in patients with obstructive and non-obstructive azoospermia]

In 10-20% of men with abnormal semen, azoosperima, the absence of sperm in ejaculation is common. Up to now, there has been no chance of pregnancy for couples in which the male partner had permanent azoospermia except by the use of donor insemination treatment but intracytoplasmic sperm injection [ICSI] has initiated a new era for azoospermic patients. The present study assessed the outcome of 50 consecutive ICSI cycles with spermatozoa surgically retrieved from azoospermic patients. In a male infertility center, 50 ICSI using precutaneouse epididymal sperm aspiration [PESA] or testicular sperm extraction [TESE] was carried out in 30 obstructive and 20 non-obstructive azoospermic patients, respectively. Fertilization and pregnancy rates were compared in two groups. One hundred and seventy two and 116 MII oocyte were injected with motile or shaking sperm, which 69.2% and 64.6% were fertilized in obstructive and non-obstructive group, respectively. The clinical pregnancy rates were 23.3% and 25% in obstructive and non-obstructive group, respectively. The ongoing pregnancy rates were similar in two groups [20%]. It seems that by using ICSI with a new sperm retrieval technique, the azoospermic patients could be potentially fertile